NICE advocate for integrated health and social care for people experiencing homelessness

NICE advocate for integrated health and social care for people experiencing homelessness by Sophia Fedorowicz and Fiona McCormack

The National Institute for Healthcare Excellence released guidance in March 2022 encouraging coordinated care across services for people experiencing homelessness and the ‘Health Inclusion’ CHAD team are delighted.

We work in partnership with local organisations including Expert Citizens CIC, Stoke-on-Trent City Council, Brighter Futures, and VOICES. For a lot of the projects we engage with stakeholders through workshops to refine findings and co-produce recommendations. We have been fortunate enough to build positive strong working relationships with many talented and passionate individuals across the third sector, the Faculty of Public Health, and within Staffordshire University and social change organisations to develop a network dedicated to making change. You can join the CHAD mailing list to stay up to date with what we’re doing and to join our network. You can also follow us on Twitter @chadresearchuk.

In recent years CHAD has produced several collaborative reports examining the experiences of people experiencing homelessness, front line workers supporting them, and stakeholders involved in designing, delivering and commissioning services to support them locally in Stoke-on-Trent and nationally.

The full NICE guidance for Integrated health and social care for people experiencing homelessness can be found HERE but we’ve pulled together some of our favourite bits for discussion in the context of our work.

1. Co-design and co-delivery of services: Recognise the value of co-designing and co-delivering services with people with lived experience of homelessness, to improve the quality of health and social care.
   • We are delighted to see this in the guidance – recognising the central importance of working with people with lived experience, which is very much part of CHAD’s health inclusion research. Many of our studies are qualitative, focusing on people’s views and experiences, and in collaboration with Expert Citizens. This also speaks to the importance of our stakeholder workshops which aim to co-produce recommendations and verify findings for our reports.

2. Take into account each person’s communication and information needs and preferences, and their circumstances. For example: consider the person’s access to phone or internet.
   • This is an extremely important point. Throughout our research we have repeatedly heard about challenges that people experiencing homelessness have with phones or internet access – phones may be lost, stolen, sold, and there can be a lack of confidence or anxiety over speaking on the phone. Also, as with the Women, Homelessness and Multiple Disadvantage project, access to phones can be controlled by others.

3. Consider providing services and support aimed at the needs of particular groups of people experiencing homelessness, as appropriate, such as: women, people with no recourse to public funds, people from different minority ethnic backgrounds.
   • Again, this was really important in the context of our studies on support and services for women, and the often ‘hidden’ nature of women’s experiences of homelessness; domestic abuse and violence against women and girls was often part of becoming homeless and also part of life whilst homeless. Locally, the Everyone In campaign saw more women than expected come forward for accommodation , which shone a light on the extent of women’s homelessness. Much of the focus so far has been on the visible majority of people experiencing homelessness and rough sleeping specifically, but there is growing recognition of differentiated experiences and needs within this and it is vital to build upon this going forward.

4. Design and deliver services in a way that reduce barriers to access and engagement with health and social care, e.g., by providing outreach services, flexible opening and appointment times, ‘one stop shops’
   • This guideline links well with findings from many of our reports including The provision of support services for women in Stoke-on-Trent, hospital discharge and homelessness and our work around COVID-19 and homelessness. Austerity measures have reduced services’ abilities to work in flexible ways and engage in outreach. It is positive to see recognition that these approaches are essential for people experiencing homelessness.

5. Do not penalise people experiencing homelessness for missing appointments, e.g., by discharging people from service and 6. Give priority to building a relationship of trust, for example by taking time with the person, particularly at the beginning of the relationship
   • These are two crucial additions to the guidance that we’re really happy to see included, and work in harmony with the previous point. The importance of building trust and having flexibility around things like appointments for people experiencing homelessness were highlighted in our evaluation of Housing First Stoke, and our reports Women, Homelessness and Multiple Disadvantage and COVID-19 and Homelessness: National policy at the local level. Creating the conditions necessary for staff to be able to provide this level of support for individuals experiencing homelessness by having low caseloads is also included in the guidance which is great to see.

With recent local (Changing Futures), national (Everyone In, Levelling up) and international strategies (UN Sustainable Development Goals), it feels like momentum is growing to make positive changes. We welcome the introduction of this guidance from NICE as part of this – it seems a promising step in the right direction. Ultimately, investment in the social determinants of health is also important for tackling homelessness – particularly in deprived areas where large funding cuts have limited local authorities’ ability to invest in and improve the social determinants of health (i.e., the conditions in which people are born, grow, live, work and age; Marmot, Allen, Boyce, et al., 2020; Marmot, Allen, Goldblatt, et al., 2020).